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Xiong J, Li X, Fu H, Luo X, Li X, Ren Y, Liu X, Zheng Q, Qi W, Liang F. Study on the specific expression of infrared radiation temperature on the body surface of acupoint in rats with chronic myocardial ischemic injury. Curr Med Imaging 2023:CMIR-EPUB-129580. [PMID: 36799419 DOI: 10.2174/1573405619666230217120343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 02/18/2023]
Abstract
Infrared thermal imaging technology was used to observe the changes in infrared radiation temperature at acupoints in rats caused by chronic myocardial ischemia injury. OBJECTIVE This study aims to compare the difference of body surface infrared radiation temperature information of three groups of acupoints: bilateral Neiguan (PC6), bilateral Yanglingquan (GB33), and bilateral Sham Acupoints (SA) in the pathological state of myocardial ischemia injury, and to explore the relationship between acupoints and viscera state. METHODS SPF adult Wistar male rats (n = 20) were randomly divided into a control (CTL; n = 10) and an isoproterenol group (ISO; n = 10). Chronic myocardial injury was induced in rats by subcutaneous injection of isoproterenol hydrochloride for 14 d. On the second day after the establishment of the model, the serum levels of cardiac troponin (cTnT) and creatine kinase isoenzyme (CK-MB) were measured by enzyme-linked immunosorbent assay (ELISA) and ELISA-like assays with aptamers (ELASA). The morphological changes of the myocardial tissue in the two groups were observed by hematoxylin-eosin (HE) staining and their pathological scores were evaluated, which was then used to determine the myocardial ischemic injury. Two days before and after the establishment of the model, the electrocardiograms (EGC) of the two groups of rats were recorded by the ECG data acquisition system, and the infrared thermal imaging platform was used to detect the temperature of the six acupoints. RESULTS 1. After subcutaneous injection of isoproterenol hydrochloride for 14 days, the ST segment of the ECG decreased in the ISO group compared with that of the CTL group; 2. Myocardial tissue injury was serious in the ISO group compared to the CTL group; 3. Serum cTnT and CK-MB were significantly increased (P <0 01) in the ISO group, compared to that in the CTL group; 4. The infrared radiation temperature on the body surface of bilateral Neiguan (PC6) acupoints decreased significantly in the ISO group, compared to that of the CTL group. CONCLUSION Infrared thermal imaging technology can be used to detect the changes in the energy state of acupoints. Chronic myocardial ischemic injury can cause a decrease in IR temperature on the body surface of bilateral Neiguan (PC6) acupoints, suggesting that visceral diseases can lead to changes in the energy metabolism of acupoints.
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Affiliation(s)
- Jian Xiong
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China, 610075
| | - Xiang Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China, 610075
| | - Hongjuan Fu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China, 610075
| | - Xinye Luo
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China, 610075
| | - Xiao Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China, 610075
| | - Yanrong Ren
- Shanxi University of Traditional Chinese Medicine, Shanxi, Taiyuan, P.R. China, 030002
| | - Xueying Liu
- Shanxi University of Traditional Chinese Medicine, Shanxi, Taiyuan, P.R. China, 030002
| | - Qianhua Zheng
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China, 610075
| | - Wenchuan Qi
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China, 610075
| | - Fanrong Liang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China, 610075
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Zhang F, Duan B, Zhou Z, Han L, Huang P, Ye Y, Wang Q, Huang F, Li J. Integration of metabolomics and transcriptomics to reveal anti- chronic myocardial ischemia mechanism of Gualou Xiebai decoction. J Ethnopharmacol 2022; 297:115530. [PMID: 35830899 DOI: 10.1016/j.jep.2022.115530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Gualou Xiebai decoction (GLXB), a well-known classic traditional Chinese medicine formula, is a recorded and proven therapy for the management of cardiac diseases. However, its pharmacological characteristics and mechanism of action are unclear. MATERIALS AND METHODS The effects of GLXB and its mechanism of action in an isoprenaline-induced rat model of chronic myocardial ischemia (CMI) were investigated by incorporating metabonomics and transcriptomics. Meanwhile, the echocardiographic evaluation, histopathological analysis, serum biochemistry assay, TUNEL assay and western blot analysis were detected to revealed the protective effects of GLXB on CMI. RESULTS The results of echocardiographic evaluation, histopathological analysis and serum biochemistry assay revealed that GLXB had a significantly cardioprotective performance by reversing echocardiographic abnormalities, restoring pathological disorders and converting the serum biochemistry perturbations. Further, the omics analysis indicated that many genes and metabolites were regulated after modeling and GLXB administration, and maintained the marked "high-low" or "low-high" trends. Meanwhile, the results from integrated bioinformatics analysis suggested that the interaction network mainly consisted of amino acid and organic acid metabolism. The results of TUNEL assay and western blot analysis complemented the findings of integrated analysis of metabolomics and transcriptomics. CONCLUSION These findings suggested that GLXB has a curative effect in isoproterenol-induced CMI in rats. Integrated analysis based on transcriptomics and metabolomics studies revealed that the mechanism of GLXB in alleviating CMI was principally by the regulation of energy homeostasis and apoptosis, which was through a multi-component and multi-target treatment modality.
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Affiliation(s)
- Fengyun Zhang
- Pharmacy School, Hubei University of Chinese Medicine, Wuhan, 430065, China; Key Laboratory of Traditional Chinese Medicine Resource and Prescription, Ministry of Education, Wuhan, Hubei, 430061, China
| | - Bailu Duan
- College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China.
| | - Zhenxiang Zhou
- College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China
| | - Lintao Han
- Pharmacy School, Hubei University of Chinese Medicine, Wuhan, 430065, China; Key Laboratory of Traditional Chinese Medicine Resource and Prescription, Ministry of Education, Wuhan, Hubei, 430061, China
| | - Ping Huang
- Key Laboratory of Traditional Chinese Medicine Resource and Prescription, Ministry of Education, Wuhan, Hubei, 430061, China; College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China
| | - Yan Ye
- Pharmacy School, Hubei University of Chinese Medicine, Wuhan, 430065, China; Key Laboratory of Traditional Chinese Medicine Resource and Prescription, Ministry of Education, Wuhan, Hubei, 430061, China
| | - Qiong Wang
- Key Laboratory of Traditional Chinese Medicine Resource and Prescription, Ministry of Education, Wuhan, Hubei, 430061, China; College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China
| | - Fang Huang
- College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China
| | - Jingjing Li
- College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China.
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Wan Q, Zhang L, Zhou Q, Han Y, Li Z, Li B. Protection of CAPE-pNO 2 Against Chronic Myocardial Ischemia by the TGF-Β1/Galectin-3 Pathway In Vivo and In Vitro. Inflammation 2021. [PMID: 34817763 DOI: 10.1007/s10753-021-01600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Although it is known that caffeic acid phenethyl ester (CAPE) and its derivatives could ameliorate acute myocardial injury, their effects on chronic myocardial ischemia (CMI) were not reported. This study aimed to investigate the potential effect of caffeic acid p-nitro phenethyl ester (CAPE-pNO2, a derivative of CAPE) on CMI and underlying mechanisms. SD rats were subjected to high-fat-cholesterol-diet (HFCD) and vitamin D3, and the H9c2 cells were treated with LPS to establish CMI model, followed by the respective treatment with saline, CAPE, or CAPE-pNO2. In vivo, CAPE-pNO2 could reduce serum lipid levels and improve impaired cardiac function and morphological changes. Data of related assays indicated that CAPE-pNO2 downregulated the expression of transforming growth factor-β1 (TGF-β1) and galectin-3 (Gal-3). Besides, CAPE-pNO2 decreased collagen deposition, the number of apoptotic cardiomyocytes, and some related downstream proteins of Gal-3 in the CMI rats. Interestingly, the effects of CAPE-pNO2 on TGF-β1, Gal-3, and other proteins expressed in the lung were consistent with that in the heart. In vitro, CAPE-pNO2 could attenuate the fibrosis, apoptosis, and inflammation by activating TGF-β1/Gal-3 pathway in LPS-induced H9c2 cell. However, CAPE-pNO2-mediated cardioprotection can be eliminated when treated with modified citrus pectin (MCP, an inhibitor of Gal-3). And in comparison, CAPE-pNO2 presented stronger effects than CAPE. This study indicates that CAPE-pNO2 may ameliorate CMI by suppressing fibrosis, inflammation, and apoptosis via the TGF-β1/Gal-3 pathway in vivo and in vitro.
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Wang X, Li X, Liu S, Brickell AN, Zhang J, Wu Z, Zhou S, Ding Z. PCSK9 regulates pyroptosis via mtDNA damage in chronic myocardial ischemia. Basic Res Cardiol 2020; 115:66. [PMID: 33180196 DOI: 10.1007/s00395-020-00832-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022]
Abstract
Proprotein convertase subtilisin/Kexin type 9 (PCSK9) and pyroptosis both play important roles in myocardial infarction. This study was designed to test the hypothesis that PCSK9 regulates pyroptosis in cardiomyocytes during chronic myocardial ischemia. Primary cardiomyocytes were isolated from WT and PCSK9-/- mice. HL-1 cardiomyocytes were used to set up PCSK9-deficient (PCSK9-/-) and PCSK9-upregulated (PCSK9CRISPRa) cardiomyocyte cell line with CRISPR/Cas9 knockout or activation plasmid. Additional studies were performed with chronic myocardial ischemia in WT and PCSK9-/- mice. We observed that PCSK9 initiates mitochondrial DNA (mtDNA) damage, activates NLRP3 inflammasome signaling (NLRP3, ASC, Caspase-1, IL-1β, and IL-18), and subsequently induces Caspase-1-dependent pyroptosis. There was an intense expression of PCSK9 and pyroptosis marker, GSDMD-NT, in the zone bordering the infarct area. PCSK9-/- significantly suppressed expression of NLRP3 inflammasome signaling, GSDMD-NT, and LDH release. Furthermore, serum levels of PCSK9, NLPR3 inflammasome signaling, and pyroptosis (GSDMD and LDH release) were significantly elevated in patients with chronic myocardial ischemia as compared to those in age-matched healthy subjects. Human hearts with recent infarcts also showed high expression of PCSK9 and GSDMD-NT in the border zone similar to that in the infarcted mouse heart. These observations provide compelling evidence for the role of PCSK9 in regulating Caspase-1-dependent pyroptosis via mtDNA damage and may qualify pro-inflammatory cytokines and pyroptosis as potential targets to treat PCSK9-related cardiovascular diseases.
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MESH Headings
- Aged
- Animals
- Case-Control Studies
- Caspase 1/metabolism
- Cell Line
- Chronic Disease
- DNA Damage
- DNA, Mitochondrial/genetics
- DNA, Mitochondrial/metabolism
- Disease Models, Animal
- Female
- Humans
- Inflammasomes/metabolism
- Inflammation Mediators/metabolism
- Intracellular Signaling Peptides and Proteins/metabolism
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Middle Aged
- Mitochondria, Heart/enzymology
- Mitochondria, Heart/genetics
- Mitochondria, Heart/pathology
- Myocardial Ischemia/enzymology
- Myocardial Ischemia/genetics
- Myocardial Ischemia/pathology
- Myocytes, Cardiac/enzymology
- Myocytes, Cardiac/pathology
- NLR Family, Pyrin Domain-Containing 3 Protein/metabolism
- Phosphate-Binding Proteins/metabolism
- Proprotein Convertase 9/genetics
- Proprotein Convertase 9/metabolism
- Pyroptosis
- Signal Transduction
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Affiliation(s)
- Xianwei Wang
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, China
| | - Xiao Li
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, China
| | - Shijie Liu
- Central Arkansas Veterans Healthcare System and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Anna N Brickell
- Central Arkansas Veterans Healthcare System and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jinghang Zhang
- Department of Pathology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Zekun Wu
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, China
| | - Sichang Zhou
- Department of Neurological Surgery, Weill Cornell Medicine, New York, USA
| | - Zufeng Ding
- Central Arkansas Veterans Healthcare System and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
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Cui X, Cao HL, Liu Q, Liu K, Gao XY, Zhu B. [Electroacupuncture at "Neiguan"(PC6) decreased cardiac sympathetic hyperactivity and improved cardiac function in chronic myocardial ischemia model rats]. Zhen Ci Yan Jiu 2020; 45:264-268. [PMID: 32333529 DOI: 10.13702/j.1000-0607.190942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the autonomic nervous mechanism of acupuncture therapy in the treatment of ischemic cardiomyopathy by observing the influence of electroacupuncture (EA) at "Neiguan"(PC6) on the superior cervical cardiac nerve activity and cardiac function in chronic myocardial ischemia (CMI) rats. METHODS Male SD rats were randomly divided into control, model and EA groups (n=8 in each group). The CMI model was established by ligating the anterior descending branch of the left coronary artery. EA (15 Hz, 1.5 mA) was applied to bilateral PC6 for 20 min, once a day for 28 consecutive days. Cardiac sympathetic nerve electrical activities (CSNEA), electrocardiogram (ECG) of the standard limb lead Ⅱ and ultrasonic cardiogram (UCG) were recorded for observing changes of ST segment height, left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS).. RESULTS The CSNEA was significantly increased(P<0.001), and the hight of ECG-STⅡ, LVEF and LVFS were considerably decreased in the model group relevant to the control group (P<0.01, P<0.001), while after the intervention, modeling induced increase of CSNEA and decrease of ECG-STⅡ, LVEF and LVFS were obviously suppressed in the EA group in comparison with the model group (P<0.01, P<0.05, P<0.001). CONCLUSION EA of PC6 can improve cardiac function and myocardial ischemia in CMI rats, which is possibly related to its effect in decreasing cardiac sympathetic hyperactivity.
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Affiliation(s)
- Xiang Cui
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hong-Lei Cao
- Department of Cardiology, Jining No.1 People's Hosptial, Jining 272011, Shandong Province
| | - Qun Liu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Kun Liu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xin-Yan Gao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Bing Zhu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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Chen Q, Wang H, Liang FX, Wu S, Hao Q, Li J, Huang W, Lu W. [Protective Effect and Metabonomics Research of "Biao-Ben Acupoint Combination" Electroacupuncture in Chronic Myocardial Ischemia Model Rats]. Zhen Ci Yan Jiu 2018; 43:698-704. [PMID: 30585466 DOI: 10.13702/j.1000-0607.170379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To observe the effect of electroacupuncture (EA) on ischemic electrocardiogram (ECG), histopathological changes and serum metabolite profile in chronic myocardial ischemia (CMI) rats, so as to reveal its mechanisms underlying protecting ischemic myocardium. METHODS A total of 45 male Wistar rats were randomly divided into normal control, CMI model and EA groups, with 15 rats being in each group. The rats in the control group received subcutaneous injection of 0.9% normal saline (5 mg•mg-1•d-1, for 7 days), and those in the model and EA groups received subcutaneous injection of isopropylarterenol hydrochloride (5 mg•mg-1•d-1, for 7 days) to establish CMI model. EA (2 Hz/100 Hz, 1 mA) was applied to bilateral "Zusanli" (ST 36), "Guanyuan" (CV 4) and "Neiguan" (PC 6) for 10 min, once daily for 21 days. The ECG-ST segment of the standard limb lead II was used for evaluating the severity of myocardial ischemia, and the histopathological changes of myocardium were observed under microscope after H.E. staining. The profile of serum metabolites was analyzed by nuclear magnetic resonance mass spectrometry combined with principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) in 21 rats (n=7 in each group).. RESULTS After modeling, the amplitude of ECG-ST was significantly increased in comparison with the normal control group (P<0.01), suggesting a successful establishment of CMI model. H.E. stain showed an apparent injury of the myocardial tissue as interstitial edema, vasodilatation and hemorrhage, infiltration of inflammatory cells, unclear veins, and increased intercellular space, etc. with irregularly arranged myocardial cells being dissolved, ruptured and necrotic, and with obvious edema, blurred shape, uneven staining, karyopyknosis, and glass-like lesions. After EA intervention, the amplitude of ECG-ST in the EA group was evidently lower than that of the model group (P<0.01), and the severity of the myocardial injury was relatively milder relevant to the model group, suggesting an alleviation of the injured myocardium. In the PLS-DA score plot, the normal control group and the EA group outline were close to each other, and Glucose, Lactate, Creatine, Acetate, 3-Hydroybutyrate might be the potential metabolic differential biomarkers (VIP > 1). The PLS-DA analysis revealed deviations in 51 differential biomarkers in serum,among which, Glucose, Lactate, Creatine, Acetate and 3-Hydroybutyrate may contribute to the effect of EA in improving CMI. CONCLUSION EA stimulation of acupoints can ameliorate ischemic myocardial injury in CMI rats, which may be related to its effect in regulating serum sugar, lipid metabolism and energy metabolism.
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Affiliation(s)
- Qian Chen
- College of Acupuncture-moxibustion and Orthopedics, Hubei Provincial Collaborative Innovation Center for Preventive Treatment of Diseases with Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan 430061, China
| | - Hua Wang
- College of Acupuncture-moxibustion and Orthopedics, Hubei Provincial Collaborative Innovation Center for Preventive Treatment of Diseases with Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan 430061, China
| | - Feng-Xia Liang
- College of Acupuncture-moxibustion and Orthopedics, Hubei Provincial Collaborative Innovation Center for Preventive Treatment of Diseases with Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan 430061, China
| | - Song Wu
- College of Acupuncture-moxibustion and Orthopedics, Hubei Provincial Collaborative Innovation Center for Preventive Treatment of Diseases with Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan 430061, China
| | - Qing Hao
- College of Acupuncture-moxibustion and Orthopedics, Hubei Provincial Collaborative Innovation Center for Preventive Treatment of Diseases with Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan 430061, China
| | - Jia Li
- College of Acupuncture-moxibustion and Orthopedics, Hubei Provincial Collaborative Innovation Center for Preventive Treatment of Diseases with Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan 430061, China
| | - Wei Huang
- College of Acupuncture-moxibustion and Orthopedics, Hubei Provincial Collaborative Innovation Center for Preventive Treatment of Diseases with Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan 430061, China; Department of Acupuncture and Moxibustion, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430061
| | - Wei Lu
- College of Acupuncture-moxibustion and Orthopedics, Hubei Provincial Collaborative Innovation Center for Preventive Treatment of Diseases with Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan 430061, China
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Guo M, Liu J, Guo F, Shi J, Wang C, Bible PW, Yang M, Tian Y, Wei L, Wang P, Shi D. Panax Quinquefolium Saponins Attenuate Myocardial Dysfunction Induced by Chronic Ischemia. Cell Physiol Biochem 2018; 49:1277-1288. [PMID: 30205393 DOI: 10.1159/000493407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Previous studies in rat models of myocardial ischemia showed that Panax quinquefolium saponins (PQS) could attenuate ischemic/reperfusion injury, increase vessel density and improve cardiac function. In the current study, we examined whether PQS could attenuate myocardial dysfunction in a swine model of chronic myocardial ischemia (CMI). METHODS CMI was established in Bama mini-pigs by placing amroid constrictor on the left anterior descending artery (LAD). Starting from 2 months after the surgery, pigs randomly received PQS (30 mg/kg/day), atorvastatin (1.5 mg/kg/day), or no drug for one month (n=6). A group of pigs receiving sham surgery was included as an additional control. Glucose utilization was assessed with positron emission tomography-computer tomography (PET-CT). Cardiac function was assessed with echocardiography. Myocyte size, nuclear density, and arteriolar density were examined in tissue section obtained from the ischemia area. Potential molecular targets of PQS were identified using proteomic analysis with isobaric tags for relative and absolute quantitation (iTARQ) and network pharmacology. RESULTS In comparison to the sham controls, pigs implanted with ameroid constrictor had decreased ventricular wall motion, left ventricular ejection fraction (LVEF), and glucose utilization. PQS significantly increased cardiac function and glucose utilization. Arteriole density and myocyte nuclear density were increased. Myocyte diameter was decreased. PQS also attenuated the CMI-induced change of protein expression profile. The effects of atorvastatin were generally similar to that of PQS. However, PQS attenuated the reduction of left ventricular systolic WT induced by CMI more robustly than atorvastatin. CONCLUSION The results from the current study supports the use of PQS in patients with coronary artery disease.
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Affiliation(s)
- Ming Guo
- Cardiovascular Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiangang Liu
- Cardiovascular Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Feifei Guo
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Junhe Shi
- Department of Periodontics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chenglong Wang
- Cardiovascular Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Paul W Bible
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Minfu Yang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yi Tian
- Department of Animal Experimental Center, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lai Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Peili Wang
- Cardiovascular Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dazhuo Shi
- Cardiovascular Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Guo S, Li P, Fu B, Chuo W, Gao K, Zhang W, Wang J, Chen J, Wang W. Systems-biology dissection of mechanisms and chemical basis of herbal formula in treating chronic myocardial ischemia. Pharmacol Res 2016; 114:196-208. [PMID: 27818233 DOI: 10.1016/j.phrs.2016.10.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/13/2016] [Accepted: 10/28/2016] [Indexed: 01/11/2023]
Abstract
Herbal medicine is a mixture of multiple compounds, and is intended to exhibit therapeutic effects by attacking multiple disease-causing modules simultaneously. However, it is still a challenge for scientists to untangle the complex biological mechanisms and underlying material basis of herbal medicine. Here, this study was designed to build a systems-biology platform for exploring the molecular mechanisms and corresponding active compounds, with a typical example applied to an herbal formula Qishenkel (QSKL) in the treatment of chronic myocardial ischemia. We have applied an approach integrating transcriptome sequencing, bioactivity profiling inference, computational ligand-receptor evaluation and experimental validation to study the effects on pig myocardial ischemia treated with QSKL. Numerous biological modules were revealed and indicated the coordinated regulation of molecular networks from various aspects of cardiac function. In addition, gene expression profiles were utilized to identify a number of key therapeutic targets of herbal formula, such as angiotensin-converting enzyme and calcium channels. Then, these therapeutic targets were used to fish the potential active ingredients based on a combination of target structure-based and chemical ligand-based methods. Some active compounds, including luteolin, cryptotanshinone, licochalcone A, glycyrrhetinic acid, salsolinol, isoacid chlorogenic C, salvianolic acid A and salvianolic acid B, have been validated by direct biochemical methods. This strategy integrating different types of technologies is expected to provide not only a detailed understanding about the combined therapeutic effects of herbal mixture but also a new opportunity for discovering novel natural molecules with pharmacological activities.
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Affiliation(s)
- Shuzhen Guo
- Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, PR China
| | - Peng Li
- ShanXi Agricultural University, Taigu, ShanXi Province, 030801, PR China
| | - Bangze Fu
- Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, PR China
| | - Wenjing Chuo
- Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, PR China
| | - Kuo Gao
- Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, PR China
| | - Wuxia Zhang
- ShanXi Agricultural University, Taigu, ShanXi Province, 030801, PR China
| | - Junyao Wang
- Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, PR China
| | - Jianxin Chen
- Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, PR China.
| | - Wei Wang
- Beijing University of Chinese Medicine, Chao Yang District, Beijing, 100029, PR China.
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Liu CB, Huang H, Sun P, Ma SZ, Liu AH, Xue J, Fu JH, Liang YQ, Liu B, Wu DY, Lü SH, Zhang XZ. Human Umbilical Cord-Derived Mesenchymal Stromal Cells Improve Left Ventricular Function, Perfusion, and Remodeling in a Porcine Model of Chronic Myocardial Ischemia. Stem Cells Transl Med 2016; 5:1004-13. [PMID: 27334487 DOI: 10.5966/sctm.2015-0298] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/10/2016] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED : Stem cell therapy has emerged as a new strategy for treatment of ischemic heart disease. Although umbilical cord-derived mesenchymal stromal cells (UC-MSCs) have been used preferentially in the acute ischemia model, data for the chronic ischemia model are lacking. In this study, we investigated the effect of UC-MSCs originated from Wharton's jelly in the treatment of chronic myocardial ischemia in a porcine model induced by ameroid constrictor. Four weeks after ameroid constrictor placement, the surviving animals were divided randomly into two groups to undergo saline injection (n = 6) or UC-MSC transplantation (n = 6) through the left main coronary artery. Two additional intravenous administrations of UC-MSCs were performed in the following 2 weeks to enhance therapeutic effect. Cardiac function and perfusion were examined just before and at 4 weeks after intracoronary transplantation. The results showed that pigs with UC-MSC transplantation exhibited significantly greater left ventricular ejection fraction compared with control animals (61.3% ± 1.3% vs. 50.3% ± 2.0%, p < .05). The systolic thickening fraction in the infarcted left ventricular wall was also improved (41.2% ± 3.3% vs. 46.2% ± 2.3%, p < .01). Additionally, the administration of UC-MSCs promoted collateral development and myocardial perfusion. The indices of fibrosis and apoptosis were also significantly reduced. Immunofluorescence staining showed clusters of CM-DiI-labeled cells in the border zone, some of which expressed von Willebrand factor. These results suggest that UC-MSC treatment improves left ventricular function, perfusion, and remodeling in a porcine model with chronic myocardial ischemia. SIGNIFICANCE Ischemic heart disease is the leading cause of death worldwide. Many patients with chronic myocardial ischemia are not suitable for surgery and have no effective drug treatment; they are called "no-option" patients. This study finds that umbilical cord-derived mesenchymal stromal cells transplanted by intracoronary delivery combined with two intravenous administrations was safe and could significantly improve left ventricular function, perfusion, and remodeling in a large-animal model of chronic myocardial ischemia, which provides a new choice for the no-option patients. In addition, this study used clinical-grade mesenchymal stem cells with delivery and assessment methods commonly used clinically to facilitate further clinical transformation.
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Affiliation(s)
- Chuan-Bin Liu
- Department of Cardiovascular Medicine, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - He Huang
- Department of Anesthesia, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Ping Sun
- Ivy Institute of Stem Cells Company Limited, Beijing, People's Republic of China
| | - Shi-Ze Ma
- Ivy Institute of Stem Cells Company Limited, Beijing, People's Republic of China
| | - An-Heng Liu
- Department of Cardiovascular Medicine, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Jian Xue
- Department of Cardiovascular Medicine, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Jin-Hui Fu
- Department of Cardiovascular Medicine, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Yu-Qian Liang
- Ivy Institute of Stem Cells Company Limited, Beijing, People's Republic of China
| | - Bing Liu
- 307-Ivy Translational Medicine Center, Laboratory of Oncology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Dong-Ying Wu
- Ivy Institute of Stem Cells Company Limited, Beijing, People's Republic of China
| | - Shuang-Hong Lü
- Department of Cardiovascular Medicine, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Xiao-Zhong Zhang
- Department of Cardiovascular Medicine, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
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Butterick TA, Hocum Stone L, Duffy C, Holley C, Cabrera JA, Crampton M, Ward HB, Kelly RF, McFalls EO. Pioglitazone increases PGC1-α signaling within chronically ischemic myocardium. Basic Res Cardiol 2016; 111:37. [PMID: 27138931 DOI: 10.1007/s00395-016-0555-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/07/2016] [Indexed: 11/29/2022]
Abstract
The peroxisome proliferator-activated receptor (PPAR)-γ drug pioglitazone (PIO) has been shown to protect tissue against oxidant stress. In a swine model of chronic myocardial ischemia, we tested whether PIO increases PGC1-α signaling and the expression of mitochondrial antioxidant peptides. Eighteen pigs underwent a thoracotomy with placement of a fixed constrictor around the LAD artery. At 8 weeks, diet was supplemented with either PIO (3 mg/kg) or placebo for 4 weeks. Regional myocardial function and blood flow were determined at the time of the terminal study. PGC1-α expression was quantified from nuclear membranes by gels and respiration, oxidant stress markers and proteomics by iTRAQ were determined from isolated mitochondria. In the chronically ischemic LAD region, wall thickening from the PIO and control groups was 42 ± 6 and 45 ± 5 %, respectively (NS) with no intergroup differences in basal blood flow (0.72 ± 0.04 versus 0.74 ± 0.04 ml/min g, respectively; NS). In the PIO group, the expression of nuclear bound PGC1-α was higher (11.3 ± 2.6 versus 4.4 ± 1.4 AU; P < 0.05) and the content of mitochondrial antioxidant peptides including superoxide dismutase 2, aldose reductase, glutathione S-transferase and thioredoxin reductase were greater than controls. Although isolated mitochondria from the PIO group showed lower state 3 respiration (102 ± 13 versus 161 ± 22 nmol/min mg; P < 0.05), no differences in oxidant stress were noted by protein carbonyl (1.7 ± 0.7 versus 1.1 ± 0.1 nmol/mg). Chronic pioglitazone does not reduce regional myocardial blood flow or function in a swine model of chronic myocardial ischemia, but may have an important role in increasing expression of antioxidant proteins through PGC1-α signaling.
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Affiliation(s)
- Tammy A Butterick
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA.,Cardiology and Cardiothoracic Surgery Sections, Department of Nutrition, VA Medical Center, Minneapolis, USA.,Minnesota Obesity Center, University of Minnesota, 1334 Eckles Avenue, St. Paul, MN, 55108, USA
| | - Laura Hocum Stone
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Cayla Duffy
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA.,Cardiology and Cardiothoracic Surgery Sections, Department of Nutrition, VA Medical Center, Minneapolis, USA
| | - Christopher Holley
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Jesús A Cabrera
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Melanie Crampton
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Herbert B Ward
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Rosemary F Kelly
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Edward O McFalls
- Cardiology and Cardiothoracic Surgery Sections, Cardiology (111C), VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA. .,Department of Surgery, University of Minnesota, Minneapolis, USA.
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11
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Mathiasen AB, Haack-Sørensen M, Jørgensen E, Kastrup J. Autotransplantation of mesenchymal stromal cells from bone-marrow to heart in patients with severe stable coronary artery disease and refractory angina--final 3-year follow-up. Int J Cardiol 2013; 170:246-51. [PMID: 24211066 DOI: 10.1016/j.ijcard.2013.10.079] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/21/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND The study assessed long-term safety and efficacy of intramyocardial injection of autologous bone-marrow derived mesenchymal stromal cells (BMMSCs) in patients with severe stable coronary artery disease (CAD) and refractory angina. METHODS Thirty-one patients with severe stable CAD and refractory angina were included. Patients had reversible myocardial ischemia and no further revascularization options. Autologous BMMSCs were isolated, culture expanded and stimulated with vascular endothelial growth-factor to facilitate endothelial differentiation. BMMSCs were injected into an ischemic, viable region of the myocardium. Patients were followed for 3 years. RESULTS We found significant clinical improvements in exercise time (p=0.0016), angina class (CCS) (p<0.0001), weekly number of angina attacks (p<0.0001) and use of nitroglycerine from (p=0.0017). In the Seattle Angina Questionnaire there were significant improvements in physical limitation score, angina stability score, angina frequency score and quality of life score (all p<0.0001). When comparing all hospital admissions from 3 years before to 3 years after treatment, we observed highly reduced admission rates for stable angina (p<0.0001), revascularization (p=0.003) and overall cardiovascular disease (p<0.0001). No early or late side-effects of the treatment were observed. CONCLUSIONS The final 3-year follow-up data after intramyocardial injection of autologous BMMSCs, in patients with severe CAD and refractory angina, demonstrated sustained clinical effects, reduced hospital admissions for cardiovascular disease and excellent long-term safety. The results indicate that autotransplantation of BMMSCs to the heart does not only improve symptoms but also slows down disease progression.
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Affiliation(s)
- Anders Bruun Mathiasen
- Cardiac Stem Cell Laboratory, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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12
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Sabe AA, Elmadhun NY, Robich MP, Dalal RS, Sellke FW. Does resveratrol improve insulin signaling in chronically ischemic myocardium? J Surg Res 2013; 183:531-6. [PMID: 23622724 PMCID: PMC3740092 DOI: 10.1016/j.jss.2013.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/20/2013] [Accepted: 03/01/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Resveratrol is a naturally occurring polyphenol believed to be cardioprotective. We previously demonstrated that resveratrol improves insulin signaling and glucose metabolism in liver and skeletal muscle of swine with metabolic syndrome. Although resveratrol has metabolic benefits in peripheral tissues, its effect on insulin signaling in ischemic myocardium (IM) is unclear. Therefore, we developed a clinically relevant swine model of metabolic syndrome and chronic myocardial ischemia to investigate the effects of resveratrol on insulin signaling in cardiac tissue. MATERIALS AND METHODS Thirteen male Yorkshire swine were fed a high-cholesterol diet for 4 wk then underwent surgical placement of an ameroid constrictor to their circumflex artery to induce chronic myocardial ischemia. The high-cholesterol control group was given no drug (n = 7). The experimental group was provided the same diet and received supplemental resveratrol (100 mg/kg/d) (n = 6). Tissue was harvested 7 wk after ameroid placement for western blot and histological analyses. RESULTS In IM, there was no significant difference between the two groups in the insulin signaling markers studied. In nonischemic myocardium, there was a significant decrease in phosphorylated AMP-activated protein kinase α (P = 0.021) in the group treated with resveratrol; otherwise, there were no significant differences between the groups. Immunostaining for glucose transporter 4 and Periodic acid-Schiff staining for myocardial glycogen stores was similar between the groups. CONCLUSIONS Resveratrol has complex effects on glucose metabolism. Although prior studies demonstrated that resveratrol supplementation improves insulin sensitivity in peripheral tissues, in chronically IM, there are no significant alterations.
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Affiliation(s)
- Ashraf A. Sabe
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Nassrene Y. Elmadhun
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Michael P. Robich
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Rahul S. Dalal
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Frank W. Sellke
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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13
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Kimura M, Toyoda M, Gojo S, Itakura Y, Kami D, Miyoshi S, Kyo S, Ono M, Umezawa A. Allogeneic amniotic membrane-derived mesenchymal stromal cell transplantation in a porcine model of chronic myocardial ischemia. J Stem Cells Regen Med 2012. [PMID: 24693195 PMCID: PMC3908291 DOI: 10.46582/jsrm.0803010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction. Amniotic membrane contains a multipotential stem cell population and is expected to possess the machinery to regulate immunological reactions. We investigated the safety and efficacy of allogeneic amniotic membrane-derived mesenchymal stromal cell (AMSC) transplantation in a porcine model of chronic myocardial ischemia as a preclinical trial. Methods. Porcine AMSCs were isolated from amniotic membranes obtained by cesarean section just before delivery and were cultured to increase their numbers before transplantation. Chronic myocardial ischemia was induced by implantation of an ameroid constrictor around the left circumflex coronary artery. Four weeks after ischemia induction, nine swine were assigned to undergo either allogeneic AMSC transplantation or normal saline injection. Functional analysis was performed by echocardiography, and histological examinations were carried out by immunohistochemistry 4 weeks after AMSC transplantation. Results. Echocardiography demonstrated that left ventricular ejection fraction was significantly improved and left ventricular dilatation was well attenuated 4 weeks after AMSC transplantation. Histological assessment showed a significant reduction in percentage of fibrosis in the AMSC transplantation group. Injected allogeneic green fluorescent protein (GFP)-expressing AMSCs were identified in the immunocompetent host heart without the use of any immunosuppressants 4 weeks after transplantation. Immunohistochemistry revealed that GFP colocalized with cardiac troponin T and cardiac troponin I. Conclusions. We have demonstrated that allogeneic AMSC transplantation produced histological and functional improvement in the impaired myocardium in a porcine model of chronic myocardial ischemia. The transplanted allogeneic AMSCs survived without the use of any immunosuppressants and gained cardiac phenotype through either their transdifferentiation or cell fusion.
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Affiliation(s)
- M Kimura
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan ; Equally contributed to the study
| | - M Toyoda
- Research Team for Geriatric Medicine, Tokyo Metropolitan Institute of Gerontology , Tokyo, Japan ; Equally contributed to the study
| | - S Gojo
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Y Itakura
- Research Team for Geriatric Medicine, Tokyo Metropolitan Institute of Gerontology , Tokyo, Japan
| | - D Kami
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - S Miyoshi
- Department of Cardiology, Keio University School of Medicine , Tokyo, Japan
| | - S Kyo
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - M Ono
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - A Umezawa
- Department of Reproductive Biology, National Research Institute for Child Health and Development , Tokyo, Japan
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